Visual processing of color and shape in people with leprosy

Abstract The aim of this study was to analyze the contrast sensitivity of spatial luminance and the color discrimination thresholds of the protan, deutan, and tritan axes of people with leprosy. This study included 8 subjects with leprosy (M = 4, W = 4, M = 33.38 ± 8.7) and 8 healthy subjects (M = 4, W = 4, M = 30.89 ± 5.8). The contrast sensitivity was evaluated by the Metropsis software version 11.0 with vertical sinusoidal grids of frequencies of 0.2, 0.5, 1, 5, 10, and 16 cycles per degree of visual angle (cpd) and color vision by the desaturated Lanthony D15 tests and the trivector and ellipse protocols of the Cambridge Color Test. The results showed significant differences between the groups in the processing of spatial frequencies of 0.2 (U = 14; p = .018); 5.0 (U = 45.0; p = .001); 10.0 (U = 45.0; p = .001), and 16.0 (U = 45.0; p = .001) cpd. The difference in color recognition through D15d (U = 4.0; p = .002). Ellipse 2 (U = 10.0; p = .012) and ellipse 3 (U = 9.0; p = .009) were discriminated against. Overall, the results indicate that leprosy changes the visual processing of low, medium, and high spatial frequencies, as well as the sensitivity of the short wavelength (tritan line of confusion) and long (protan line of confusion) cones.

Cutaneous mucormycosis of scalp and eyelids in a child with type I diabetes mellitus.

Scalp mucormycosis in children is extremely rare. We present a case of pediatric scalp mucormycosis caused by Rhizopus oryzae in a 9-year-old diabetic girl who was successfully diagnosed and treated with amphotericin B deoxycholate and wound debridement. At 3 months follow up, the patient was stable although she had lost her vision.

Ocular disability--WHO grade 2 in persons affected with leprosy.

Leprosy remains to be a leading cause of peripheral neuropathy and disability. In recent years under Leprosy control programme more stress is being laid on disability assessment. This study was aimed to find prevalence of grade of Ocular disability among persons affected with leprosy (PAL) according to WHO disability grading scale and to find Ocular contributors to grade 2 disability in PAL. A cross sectional study was carried out in tertiary care hospital in Lucknow, Uttar Pradesh. About 302 PAL were interviewed and their eyes clinically examined during 2 years. Data was analysed in percentages, x2 test, Anova. Ocular disability was found in 39.40% persons affected with leprosy (PAL). Of 604 eyes, 13.07% had grade 1 disability and 19.86% had grade 2 disabilities. Bilateral disability was more common than unilateral disability. Ocular disability was more common in PAL with more than one year of leprosy and even higher in those staying in leprasoria (p = 0.012). The most common cause of ocular grade 2 disabilities was corneal involvement (14.23% PAL). Cataract was found to be the most common cause of visual disability (although it is not caused by leprosy). Screening for ocular disability should be incorporated as a routine protocol in PAL to reduce the severity of Ocular disability. Early diagnosis and prompt preventive measure is essential to reduce the burden of visual impairment and blindness in PALthus bringing down the load of grade 2 disability due to leprosy in the society which in itself is an indicator of leprosy control.

The prevalence of ocular complications in leprosy patients seen in the United Kingdom over a period of 21 years.

OBJECTIVE: The objective of this study was to determine the prevalence of ocular complications and blindness among leprosy patients presenting in the United Kingdom. METHODS: Observational prospective study. RESULTS: A total of 126 consecutive leprosy patients attending their ophthalmic visit were examined, out of which 18 patients were blind in one eye (14.3%) and five patients were blind in both the eyes (4.0%). Visual acuity of ≥ 6/18 was present in 96 patients (76.2%). A total of 65 patients (51.6%) had an ocular complication and 28 patients (22.2%) had a sight-threatening leprosy complication (lagophthalmos, severe corneal, or iris disease). The most common ocular complications were impaired lid closure (24 patients, 19%), impaired corneal sensation (20 patients, 15.9%), cataract (20 patients, 15.9%), mild corneal opacity (17 patients, 13.5%), and iris atrophy (17 patients, 13.5%). Impaired corneal sensation was associated with vision <6/18 (P<0.001, OR 13.5, 95% CI 5.14-35.44) and vision <3/60 (P=0.01 OR 6.42, 95% CI 2.15-19.15). Impaired lid closure was significantly associated with increasing age (P=0.029, OR 1.039, 95% CI 1.0-1.08) and vision <3/60 (P=0.03, OR 6.06, 95% CI 1.81-20.24). CONCLUSION: There is a significant rate of ocular complications and blindness seen in leprosy patients in the United Kingdom, and over one in five had a potentially sight-threatening ocular complication. Health professionals and all leprosy patients, including those cured of the disease, need to be aware that new eye symptoms and signs require prompt ophthalmology review to prevent avoidable blindness, due to the life-long risk of sight-threatening ocular complications.

Visual impairment in patients with leprosy in Adilabad District in the state of Andhra Pradesh, India.

The aim was to estimate the prevalence of eye problems in patients with leprosy and to assess the utilization rate of eye care services using cross-sectional case series design. All leprosy patients registered between April 2007 and June 2009 were included in the study. They were prospectively assessed by an internist for general health issues. An ophthalmic examination including assessment of visual acuity was conducted by an ophthalmologist. A total of 150 leprosy patients were examined, of which 78 (52%) suffered from pausi bacillary (PB) leprosy and majority were males (52%); 43 (29%) patients were literate. Nineteen (14%) patients had organ deformities and ocular lesions were seen in 12 (8%) patients, but 76 (51%) (95% CI 40.8-62.7) patients had earlier reported eye problems requiring intervention as assessed by the ophthalmic officer. Only 26 (17%) (95% CI 11.6-24.4) patients had sought eye care services earlier. Visual impairment was observed in 19 (12.6%) cases and blindness related to leprosy was seen in 5 (3.3%) patients. To conclude prevention of blindness among leprosy patients is possible only with strong coordination between the general health and eye care unit in the area with mandatory eye screening being made part of the treatment schedule for leprosy patients.

Evolution of vision reducing cataract in skin smear positive lepromatous patients: does it have an inflammatory basis?

AIM: To describe the incidence and risk factors of vision reducing cataract in skin smear positive lepromatous patients. METHODS: Prospective longitudinal cohort study: 212 newly diagnosed lepromatous patients were followed during the two years of treatment with multidrug therapy and for a further five years, with biannual ocular examinations. Incidence of vision reducing (< or =6/18) cataract was calculated as the number of patients with cataract per person year of cataract-free follow up among those who did not have cataract at baseline. RESULTS: Cataract was present in 27 (11%) of lepromatous patients at diagnosis. Forty nine patients (2.87%/person year (95% confidence interval (CI), 2.17% to 3.80%)) developed cataract during a total follow up period of 1704 person years; 45 of these were > or =41 years old and were followed for a total of 638 person years with an incident rate of 0.070 (95% CI, 0.0523 to 0.094). Stepwise multiple regression confirmed the association of age (per decade) (hazard ratio (HR) = 2.50 (95% CI, 1.82 to 2.78), p<0.001), clofazimine crystals on the cornea (HR = 49.92 (5.48 to 454.82), p = 0.001), grade 2 deformity in all limbs (HR = 3.17 (1.12 to 8.97), p = 0.029), and uveal inflammation (HR = 3.52 (1.42 to 8.67), p = 0.006). No significant association was found with oral steroids. CONCLUSIONS: Cataract develops at the rate of 7%/person year in lepromatous patients over 40 years of age. It is associated with increasing age, subclinical intraocular inflammation, and grade 2 deformity.

Incidence of ocular complications in patients with multibacillary leprosy after completion of a 2 year course of multidrug therapy.

AIM: To evaluate the incidence of and risk factors for ocular complications in multibacillary (MB) leprosy patients following completion of 2 year, fixed duration, multidrug therapy (MDT). METHODS: Biannual eye examinations were conducted prospectively on a cohort of MB patients who had completed MDT and followed up for 5 years. The incidence of ocular pathology was calculated as the number of events per person year of event free follow up of patients who did not have the specific finding before completion of MDT. RESULTS: 278 patients had one or more follow up visits after completion of MDT. The incidence of lagophthalmos was 0.24%/patient year (95% CI 0.10% to 0.37%); corneal opacity, 5.35%/patient year (95% CI 4.27% to 6.70%); uveal involvement, 3.78%/patient year (95% CI 2.96% to 4.83%); and cataract that reduced vision to 6/18 or less, 2.4%/patient year (95% CI 1.77% to 3.26%). Overall, 5.65%/patient year (95% CI 4.51% to 7.09%) developed leprosy related ocular disease and 3.86%/patient year (95% CI 3.00% to 4.95%) developed leprosy related, potentially blinding ocular pathology during the period following MDT. Age and other disability also predicted incident eye disease. CONCLUSIONS: Every year, approximately 5.6% of patients with MB who have completed MDT can be expected to develop new ocular complications of leprosy, which often (3.9%) are potentially vision threatening. Because many of these complications cannot be detected without slit lamp examination, periodic monitoring, particularly of older patients and those with other disability, is recommended, in order to detect and treat ocular complications satisfactorily.

Impaired contrast sensitivity among leprosy patients with normal visual acuity.

Contrast sensitivity is a person's ability to identify an object from its background. Patients with normal visual acuity can have reduced contrast sensitivity and may experience trouble in identifying objects at night or moving around in dimly lit places. Contrast sensitivity has never been studied in leprosy patients having normal visual acuity. This study aimed to determine if contrast sensitivity is impaired in leprosy patients who have normal visual acuity and to identify possible associations with demographic, leprosy and ocular characteristics. A hospital based study measuring and comparing contrast sensitivity using the VCT 6500 chart in 127 consecutive leprosy patients without clinically apparent ocular complications and 123 non-leprosy controls was done. Contrast sensitivity was impaired in leprosy patients in all five spatial frequencies (1.5, 3.0, 6.0, 12 and 18 cycles/degree) investigated. Among leprosy patients, contrast sensitivity falling outside the normative range was associated with increasing age (adjusted OR 1.28, 95% CI: 1.14-1.42), being female (adjusted OR 11.05, 95% CI: 2.93-41.69) and having a grade 2 deformity (adjusted OR 6.43, 95% CI:1.68-24.61). Contrast sensitivity is impaired in leprosy patients having normal visual acuity. Elderly, deformed, female patients are particularly burdened with this vision loss.

The eye in systemic infection.

Bacterial, fungal, viral, and parasitic pathogens all cause systemic infection and can spread to the eye. Dissemination of pathogens via the bloodstream can lead to direct involvement of the eye. Visual loss is common in bacterial or fungal endophthalmitis, and toxoplasmosis is a major cause of ocular morbidity and poor vision after congenital or acquired infection. Some infections cause intraocular damage by indirect mechanisms (eg, HIV-mediated immunosuppression), leading to opportunistic infections such as cytomegalovirus infection, periocular nerve involvement due to leprosy, and hypersensitivity reactions in tuberculosis. Eye symptoms might indicate the outcome of an underlying infection, such as development of retinal ischaemia in severe malaria, which is associated with a poor prognosis. Successful outcome for patients with ocular infection depends on close collaboration between clinicians identifying and treating underlying disease, specialist ophthalmic review, and ophthalmic interventional skills (when needed).

[Ocular impairment in leprosy].

Leprosy causes several ocular disorders, and it also causes aftereffect with high frequency in various ways. Primary impairment is the ocular disturbance caused with direct invasion of nerve and ocular tissue by Mycobacterium leprae. Secondary impairment is the complication of nerve paralysis and residual inflammation due to primary disorder. Main work at Japanese national leprosariums has been the control of primary and secondary impairment in recent years. Clinical ophthalmic study in the leprosarium revealed a increase of age-related ocular disease in addition to aftereffect of leprosy. Severe sequelae due to sensory and functional disturbance will require suitable applications of advanced clinical technologies.

Ocular complications in newly diagnosed borderline lepromatous and lepromatous leprosy patients: baseline profile of the Indian cohort.

AIM: To describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India. METHODS: Ocular complications, at enrolment, occurring in all new borderline lepromatous and lepromatous leprosy patients detected by active case finding within the geographically defined leprosy endemic area of the Gudiyattam Taluk in India from 1991 to 1997 who consented to ocular examinations every 6 months, during and 5 years after treatment with multidrug therapy (MDT), were studied. RESULTS: Orbicularis oculi weakness (4.62%), lagophthalmos (4.20%), ectropion (0.42%), trichiasis (0.84%), blocked nasolacrimal ducts (1.68%), pterygium (11.34%), impaired corneal sensation (53%), corneal opacity (10.5%), corneal nerve beading (1.68%), punctate keratitis (1.26%), keratic precipitates (4.62%), iris atrophy (1.68%), and cataract (12.6%) were ocular complications seen in the 301 lepromatous patients at enrolment. 4.6% had blind eyes. Increasing age was associated with ocular complications. 80% of patients were skin smear acid fast bacilli (AFB) positive. The LL/BL ratio was 1:6.4. 71% had some limb deformity. 44% had only leprosy related ocular complications (LROC), 28% had only general ocular complications (GOC) while 14% had both LROC and GOC. Ocular complications were significantly related to leg deformities. Corneal nerve beading was seen most in LL patients (100%) having high bacterial content. Lagophthalmos and muscle weakness were associated with reversal reactions. CONCLUSIONS: Corneal nerve beading occurs in LL patients with high bacillary count. Patients with reversal reaction are more likely to present with orbicularis oculi weakness and lagophthalmos. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients. Elderly, deformed, skin smear positive, lepromatous patients are associated with increased ocular morbidity and form a group that require acceptable and accessible eye care.

Ocular complications in newly diagnosed borderline lepromatous and lepromatous leprosy patients: baseline profile of the Indian cohort

Aim: To describe ocular manifestations in newly diagnosed borderline lepromatous (BL) and lepromatous leprosy (LL) patients in India. METHODS: Ocular complications, at enrolment, occurring in all new borderline lepromatous and lepromatous leprosy patients detected by active case finding within the geographically defined leprosy endemic area of the Gudiyattam Taluk in India from 1991 to 1997 who consented to ocular examinations every 6 months, during and 5 years after treatment with multidrug therapy (MDT), were studied. RESULTS: Orbicularis oculi weakness (4.62 per cent), lagophthalmos (4.20 per cent), ectropion (0.42 per cent), trichiasis (0.84 per cent), blocked nasolacrimal ducts (1.68 per cent), pterygium (11.34 per cent), impaired corneal sensation (53 per cent), corneal opacity (10.5 per cent), corneal nerve beading (1.68 per cent), punctate keratitis (1.26 per cent), keratic precipitates (4.62 per cent), iris atrophy (1.68 per cent), and cataract (12.6 per cent) were ocular complications seen in the 301 lepromatous patients at enrolment. 4.6 per cent had blind eyes. Increasing age was associated with ocular complications. 80 per cent of patients were skin smear acid fast bacilli (AFB) positive. The LL/BL ratio was 1:6.4. 71 per cent had some limb deformity. 44 per cent had only leprosy related ocular complications (LROC), 28 per cent had only general ocular complications (GOC) while 14 per cent had both LROC and GOC. Ocular complications were significantly related to leg deformities. Corneal nerve beading was seen most in LL patients (100 per cent) having high bacterial content. Lagophthalmos and muscle weakness were associated with reversal reactions. CONCLUSIONS: Corneal nerve beading occurs in LL patients with high bacillary count. Patients with reversal reaction are more likely to present with orbicularis oculi weakness and lagophthalmos. Leprosy related ocular complications and general ocular complications are significant problems in newly diagnosed lepromatous patients. Elderly, deformed, skin smear positive, lepromatous patients are associated with increased ocular morbidity and form a group that require acceptable and accessible eye care.

Alterações oftalmológicas em pacientes hansenianos do Hospital São Julião / Ocular disorders in Hansen's disease patients of São Juliao Hospital

Objetivo: Verificar as alterações oculares mais prevalentes em 1008 pacientes portadores de hanseníase. Local: Hospital São Julião, Campo Grande - MS. Método: Foi realizado um levantamento das alterações oculares em 1008 pacientes hansenianos do Hospital São Julião, através de protocolos específicos, durante o período de agosto de 1998 a dezembro de 2000, e consequentemente processamento dos dados existentes. Resultados: Dos pacientes examinados, 43.3 porcento (437 casos) eram da forma virchowiana, 18.7 porcento (188 casos) da forma dimorfa, 14.3 porcento (144 casos) da forma tuberculóide, 5.5 porcento (56 casos) da forma indeterminada e 18.2 porcento (183 casos) não tiveram sua forma clínica devidamente preenchida em seu protocolo específico para as alterações oculares. A alteração mais comum, das quais pesquisamos, foi a diminuição da sensibilidade corneana, atingindo 35.3 porcento dos pacientes (356 casos). A segunda mais comum foi a paresia, presente em 28 porcento dos pacientes (282 casos), seguida pela madarose, com uma prevalência de 27.2 porcento (274 casos). A hipossecreção lacrimal (teste de Schirmer < 5 mm) esteve presente em 20.4 porcento (206 casos) dos pacientes. Setenta e quatro porcento dos hansenianos (746) casos tinham acuidade visual compatível com a normalidade (visão igual ou melhor que 20/30) em pelo menos um dos olhos. Catarata, lagoftalmo, triquíase, ectrópio e úlcera de córnea estiveram presentes em, respectivamente, 13.2 porcento (133 casos), 13 porcento (131 casos), 6 porcento (60 casos), 3.8 porcento (38 casos) e 1.1 porcento (11 casos) dos pacientes. Lesões oculares graves foram achados incomuns neste estudo, o que, em parte, se deve ao tratamento precoce e acompanhamento rotineiro desses pacientes. Conclusão: Comparando os dados deste estudo com trabalhos semelhantes de diferentes autores, concluímos que, em alguns aspectos, houve uma grande variabilidade dos dados encontrados. Atribuímos isso a vários fatpres relacionados à metodologia, qualidade e quantidade da amostra, condições de trabalho e outros que, por si só, poderiam explicar tais diferenças.

Envolvimento ocular em paciente com hanseníase / Ocular involvement in leprosy patient

Objetivo: Relatar um caso de hanseníase com comprometimento ocular. Local: Núcleo de Ensino, Pesquisa e Assistência em Infectologia. Hospital das Clínicas. Universidades Federal de Pernambuco/Fundação Altino Ventura. Relato de caso: Paciente de 20 anos que desenvolveu lagoftalmo e conseqüente ceratite de exposição, resultante da ação neurotrófica do bacilo de Hansen, que só teve seu diagnóstico ocular quatro meses após ter iniciado tratamento específico para hanseníase. Comentários: Enfatiza-se a importância do exame ocular precoce em pacientes com Hanseníase.